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2015
Myocardial Infartion=
Death of myocardial cells.
Fibrous plaque
Positive remodeling
Soft plaque
LAD
Calcific nodule
Thrombus
What are the Big 5 medications for
CAD?
1. BB
2. ASA/antiplatelet agents
3. Statins
4. Nitrates
5. Antihypertensive and other risk
factor medications
NTG
ASA
Heparin Beta blockers
GPBs CA blockers
ACEI
Statins NTG
Ranolazine
ECG
Stress ECG
Systolic Dysfunction
Stress Echo/MRI
Diastolic Dysfunction
Perfusion
Nuclear Imaging
Abnormalities
Antman EM, Anbe DT, Armstrong PW, et al. www.acc.org/clinical/guidelines/stemi/index.pdf. Updated 2004.
Accessed June 20, 2007.
Key Features of an ECG
Marieb EN, Hoehn K. Human Anatomy and Physiology. 8th ed. San Francisco, CA:
Pearson Benjamin Cummings; 2010.
Example of ST-segment Elevation (STEMI)
J point
STE
Example of ST-segment Depression
(UA/STEMI)
STD
J point
Example of T-wave Inversion (UA/STEMI)
T wave changes
Normal 12-lead ECG
LATERAL
ANTERIOR
LATERAL
INFERIOR
T-wave inversion
3-Day-Old MI (STEMI)
T-wave inversion
Treatment of Acute Coronary Syndrome
Shapiro BP, Jaffe AS. Cardiac biomarkers. In: Murphy JG, Lloyd
MA, editors. Mayo Clinic Cardiology: Concise Textbook. 3rd ed.
Rochester, MN: Mayo Clinic Scientific Press and New York:
Informa Healthcare USA, 2007:77380.
Anderson JL, et al. J Am Coll Cardiol 2007;50:e1e157, Figure 5.
Troponin Elevation and Likelihood for
Mortality
% mortality at 8 Antman EMl. N Engl J Med. 1996; 335: 1342-1349.
42 days
0
<0.4 <1.0 <2.0 <5.0 <9.0 9.0
Troponin levels
Non-MI Causes of Troponin Elevation
15 .0
P=0.0002
P=0.0003 P<0.0001
10 .0 8.5
7.2 7.3 7 .2 6.8
4.9 P=0.0004
5.0 2.8 2.0 1.0
0.0
D eath D eath R e in farctio n R ecu rren t S tro ke
SH OC K isch em ia
exc l.
Presentation AccessWireBalloon
ASA
Statin
Importance of Rapid Reperfusion in STEMI
Aortic dissection
Pulmonary embolus
Perforating ulcer
Pericarditis
GERD (Gastroesophageal reflux disease)
Heart failure, Pneumonia, Pneumothorax